New article from Dr. Bruce Ramshaw – Value over Volume focus

Hernia Discussion Forums Hernia Discussion New article from Dr. Bruce Ramshaw – Value over Volume focus

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    • #28105
      Good intentions

      Here is a new article from Dr. Bruce Ramshaw. It is disturbing, in several ways, but explains, I think, to a degree, why he made recent career changes.

      Dr. Ramshaw was very active in the hernia repair field and a major proponent of mesh for hernia repair. He was also the chair of surgery at the University of Tennessee Department of Surgery Graduate School of Medicine until a short while ago.

      In his article he explains how and why his thinking about the medical field has shifted, from the mass production assembly-line view, get ’em in – get’ em out model, to a focus on value for the individual patient. Unfortunately, apparently, it took a serious error on his part, apparently from overwork, to cause him to pause and re-evaluate what he was doing in his career.

      Regardless, he now has stepped back and is taking a hard look at what is going on in the field. I hope that he can be as objective about the fine details of surgery, applying the same critical thinking to the use of mesh for hernia repair for example, as he seems to be doing in the looking at the broader system.

      Considering what happened to Dr. Ramshaw (and his patient), a top-level well-respected professional in his field, you have to wonder how many other surgeons are on the same path that he was. Churning out those hernia repairs and other surgeries, checking the boxes, and moving on to the next one. And how can they truly consider an individual patient’s care, if they are always looking ahead to the next surgery, but doing little follow-up on the last one?

      I wish him luck, and hope that many of his colleagues will join and help him in his new effort.

      From the article –

      “During the past few years, the awareness of the potential harm to patients and physicians in a volume model has been raised. There has been a growing concern about the practice of concurrent operations and the systemic nature of physician burnout and suicide. But we need to do much more. If a system is unjust, we shouldn’t teach conformity—we should change the system.”

    • #28108
      Good intentions

      Here are Dr. Ramshaw’s thoughts from just about a year and a half ago. Still weighted heavily toward monetary issues for the industry. I hope his new definition of “value” is much more skewed toward the patient.

      Quote –

      “The relationship between mesh and chronic pain is poorly understood, Dr. Ramshaw said. “Let me be clear: Mesh doesn’t cause chronic pain but it may be a contributing factor as part of the many factors that can contribute to chronic disabling pain.”

      For many years, the main outcome measure in hernia patients was recurrence, Dr. Ramshaw said. But surgeons need to consider more than just recurrence when weighing mesh choice. “We can’t just look at one specific outcome measure. The outcome measure, I think we’re learning, that’s most important to measure is value—financial measurements combined with outcome measurements.”

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